Method of using an intraocular lens insertion guide

ABSTRACT

An insertion guide for aiding the insertion of the superior haptic of an intraocular lens into the capsular bag of the eye during intraocular surgery. The guide is made of a thin, flexible material and has a body portion and a flap portion connected by an integral connecting portion which permits the flap to move from the first position folded against the body portion to a second position where the flap is disposed at an acute angle to the body portion so that the flap will act as a backstop to guide the superior haptic of an intraocular lens into the capsular bag. The present invention also relates to the method of inserting an intraocular lens using this guide.

This is a division of application Ser. No. 656,387, filed Oct. 1, 1984.

FIELD OF THE INVENTION

A device for aiding the insertion of an intraocular lens into the eyeand, more particularly, for aiding the insertion of the superior hapticof an intraocular lens into the capsular bag.

BACKGROUND OF THE INVENTION

It is now commonly accepted that the vision impairing disease known ascataracts can be alleviated by surgically replacing the natural lens ofthe eye with an artificial intraocular lens.

The anatomy of the eye is shown schematically in FIG. 2. The cornea 2forms the front surface of the eye and connects with the cilliary muscle3 from which iris 4 extends. Iris 4 divides the front portion of the eyeinto the anterior chamber 5 in front of iris 4 and the posterior chamber6, behind iris 4. The pupil 7 is the aperture at the center of iris 4through which light passes to posterior chamber 6 and onto the back ofthe eye (not shown).

The condition of cataracts is characterized by the clouding oropacification of the natural lens of the eye so that the amount of lightwhich reaches the retina is substantially reduced or completelyeliminated. The natural lens of the eye is encased in a capsular bag 8,as shown in FIG. 2, which is supported by suspensory ligaments, orzonules, 9 from cilliary muscle 3.

During intraocular lens surgery, the natural lens of the eye is removedby a variety of methods well known to those skilled in the art. Thefront surface of the capsular bag is removed so that an artificialintraocular lens may be placed in capsular bag 8. The eye shownschematically in FIGS. 2, 3 and 5 through 8 has the natural lens and thefront surface of capsular bag 8 removed so that the eye is ready for theinsertion of the intraocular lens.

There are a wide variety of artificial intraocular lenses that have beenused to replace the natural cataract lens. One particularly desirablestyle of lens is designed to fit completely within capsular bag 8. Thetype of lens suitable for insertion in the capsular bag is shown in FIG.4, identified by reference character 10. This lens has two principalparts: a medial, light-focusing body 14 (also called the optic) made ofa nontoxic plastic material which will replace the natural lens of theeye and focus light on the retina, and haptic support portions 16 and 18which extend from optic 14 to the anatomy of the eye and provide meansfor fixing and holding optic 14 in its proper position within the eye.

Referring again to FIG. 2, there is shown an incision 12 at the edge ofthe eye through which the lens will be inserted. The patient is usuallylying on his back with the doctors standing facing the top of thepatient's head. The incision would be made at a position called thesuperior part of the eye, and the intraocular lens is inserted from thesuperior portion of the eye toward the inferior portion of the eye. Thefirst haptic to be inserted into the eye is called the inferior haptic.The second haptic to be inserted into the eye is called the superiorhaptic. This terminology of inferior position and superior position isgenerally used in the industry, and inferior positions are those spacedfurther away from the entrance incision, and superior positions arethose spaced closer to the entry incision.

When a surgeon inserts an intraocular lens 10, like that shown in FIG.4, into the eye through incision 12, the inferior haptic is placedagainst the inferior internal surface of capsular bag 8. The lens isthen maneuvered into the capsular bag, and then the superior haptic isplaced in capsular bag 8. Many surgeons have difficulty placing thesuperior haptic in capsular bag 8, because it is very hard to reach andit cannot be easily visualized by the surgeon. Thus, even though thesuperior haptic may appear to be placed in the superior side of capsularbag 8, it is very difficult to confirm that that is actually the case.It would be desirable if there were an insertion tool that would easily,quickly and reliably permit the surgeon to be assured that he had placedthe superior haptic of the lens in capsular bag 8.

SUMMARY OF THE INVENTION

The present invention provides an intraocular lens insertion guide whichmakes it possible to easily insert the superior haptic of an intraocularlens into capsular bag 8. The lens insertion guide includes a bodyportion, a flap portion and a connecting portion integrally connectingthe body and flap portions. The material of the connecting portionreceives a permanent set that permits the flap to be disposed at apredetermined angle with respect to the body portion. The material ofthe guide is flexible so that the flap may be folded into a firstposition adjacent the body portion to facilitate insertion of the guideinto the eye. The flap opens to a second position after inferior or thedistal end of the guide has been inserted through the pupil intocapsular bag 8. The guide is then withdrawn superiorly until the flapportion is adjacent the superior portion of capsular bag 8. The lens maybe inserted, and the flap portion of the guide acts as a backstop toguide the superior haptic of the intraocular lens into the superiorportion of capsular bag 8.

The material of the guide is thin and flexible so that the guide may beeasily removed by pulling on the body portion and unfolding the flap sothat it is aligned straight with the body portion. Alternatively, astylus can be introduced through the incision and placed against theback of the flap while the body portion is withdrawn to facilitateunfolding of the flap portion.

In an alternative embodiment, an insertion tube may be placed in theeye, and then the lens guide inserted through the lumen of the tube.This lens tube further facilitates the removal of the lens guide. Onemerely moves the insertion tube inferiorly until the distal end of theinsertion tube abuts the flap portion of the lens guide. The bodyportion of the lens guide is then retracted through the insertion tube,and the flap is unfolded against the distal end of the insertion tubeand then slides out through the insertion tube.

These and other features and advantages of the present invention becomemore apparent when taken in conjunction with the following detaileddescription of the preferred embodiments and the following drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a perspective view of the lens insertion guide of thepresent invention;

FIG. 2 shows a schematic representation of the forward portion of theeye and the lens insertion guide as it is being inserted into the eye;

FIG. 3 shows the lens insertion guide of FIG. 2 in a different position;

FIG. 4 shows a typical intraocular lens;

FIGS. 5-7 show an intraocular lens being inserted into the eye using thelens insertion guide of the present invention;

FIG. 8 shows an alternative embodiment of the present invention; and,

FIG. 9 shows a further alternative embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now to FIG. 1 there is shown the lens insertion guide 20 ofthe present invention, including a body portion 22, a flat portion 24and a connecting portion 26. Guide 20 is preferably made of a thin,flexible material which will not interact with the eye, for example,thin metal like stainless steel or plastic like polyethylene orpolypropylene. Guide 20 is preferably about 4 millimeters wide, bodysection 22 is preferably about 40 millimeters long and flap portion 24is preferably about 4 millimeters long. The material of guide 20 ispreferably about 0.003 inches thick. These materials and dimensions arelisted as preferred materials and dimensions for the guide of thepresent invention and are not intended to limit the present invention tothese materials or dimensions.

Guide 20 is preferably manufactured flat, and the edges are trimmed andsmoothed so as not to cause any irritation to the eye during use. Guide20 is then bent at connecting portion 26 to form a permanent set so thatin the relaxed condition, flap 24 is disposed at an acute angle withrespect to body portion 22, with flap portion 24 being folded backtoward body portion 22. The cutting, smoothing and folding operationsare performed by well known procedures.

Referring now to FIG. 2, guide 20 of the present invention is used tohelp insert an intraocular lens into capsular bag 8 of the eye. Anincision 12 is made in the edge of the eye, the cataract lens is removedfrom capsular bag 8 and the inside of capsular bag 8 is cleaned byprocedures well known to intraocular surgeons. Guide 20 is insertedthrough incision 12 with flap 24 folded against body portion 22 withconnecting portion 26 entering the wound first. Guide 20 is insertedinto the eye past the superior edge of iris 4, into capsular bag 8 andtoward the inferior surface of the inside of capsular bag 8. When flap24 clears the superior edge of iris 4, flap 24 unfolds to assume itsrelaxed condition (see phantom position in FIG. 2) determined by thepermanent set of flap portion 24 with respect to body portion 22.

Referring now to FIG. 3, guide 20 is withdrawn superiorly untilconnecting portion 26 abuts the superior edge of iris 4.

Referring now to FIG. 5, intraocular lens 10 is now inserted throughincision 12 along body portion 22 of guide 20 until the inferior haptic18 of lens 10 abuts the internal inferior surface of the capsular bag 8.Lens 10 is then further inserted inferiorly collapsing inferior haptic18 against the inferior internal surface of capsular bag 8 until optic14 clears the superior edge of iris 3 and connecting portion 26 of guide20. Superior haptic 16 is then maneuvered over connecting portion 26 andpermitted to slide along flap portion 24 of guide 20 into the superiorinternal surface of capsular bag 8. Flap portion 24 acts as a backstopto guide superior haptic 16 into its proper position within capsular bag8. Various surgical instruments may be used by the surgeon to maneuverintraocular lens 10 during the insertion procedure.

Referring now to FIG. 7, there is shown insertion guide 20 in phantom asit is removed from the eye through incision 12. The surgeon merelygrasps body portion 22 of guide 20 and withdraws it slowly from the eye.The force exerted on flap portion 24 by iris 4 or capsular bag 8 willpermit flap portion 24 to unfold so that it extends generally in theaxial direction from body portion 22. After the removal of insertionguide 20 from the eye, the remaining well known procedures forintraocular lens insertion surgery are performed.

Referring now to FIGS. 8 and 9, there is shown an alternative method forinserting lens guide 20 into the eye and for removing lens guide 20 fromthe eye. There is shown in FIG. 9 an insertion device 30 which includestwo flat, hollow sections 32 and 34, designated, respectively, as a lensguide insertion tube 32 and a lens insertion tube 34.

Referring now to FIG. 8, there is shown a separate lens guide insertiontube 32 without the lens insertion tube 34 mounted on it. Lens guide 20may be inserted through the lumen of lens guide insertion tube 32 intothe eye until flap portion 24 unfolds, as previously described. Lensguide 20 is then positioned near the superior edge of iris 4, and anintraocular lens can be inserted through incision 12 in the same fashionas previously described. After lens 10 is fully inserted in capsular bag8, lens guide 20 may be removed by sliding guide insertion tube 32inferiorly into the eye until the inferior end 36 of guide insertiontube 32 rests in the vicinity of the superior edge of iris 4 and nearconnecting portion 26 of guide 20. The surgeon then withdraws guide 20while holding guide insertion tube 32 in position, so that flap portion24 will pivot about the inferior edge 36 of insertion guide 32. Thus, noadditional forces are exerted on the interior anatomy of the eye,particularly on iris 4 and capsular bag 8, during removal of guide 20.

Still referring to FIG. 8, there is shown an alternative method ofinserting a lens using a glide 40 much like the well-known Sheets glide.Glide 40 is inserted through the lumen of guide insertion tube 32 eitherafter guide 20 is in place or before guide 20 is inserted into the eye.The inferior edge 42 of glide 40 is directed into the inferior, internalsurface of capsular bag 8 to form a ramp along which an intraocular lensmay be directed into capsular bag 8. Once the inferior haptic of anintraocular lens is inserted into the inferior portion of the internalsurface of capsular bag 8, glide 40 is withdrawn, and the procedure forinserting the superior haptic of the lens is completed as describedabove.

Referring again to FIG. 9, a lens insertion tube 34 may be piggybackedon guide insertion tube 32 to provide a tube through which the lensitself may be inserted into the eye. With the device shown in FIG. 9,lens guide 20 may be inserted through guide insertion tube 32, aspreviously described, and then the lens itself may be inserted throughlens guide tube 34. Lens guide insertion tube 34 may extend along thecomplete axial distance of guide insertion tube 32 or it may extendalong only a portion thereof.

The present invention has been described in conjunction with certainpreferred embodiments. Those skilled in the art will realize thatcertain modifications and changes may be made to these preferredembodiments without departing from the scope of the present invention.It is, therefore, not intended that the present invention be limitedexcept as set forth in the following claims.

I claim:
 1. A method of inserting an intraocular lens having an opticand a plurality of support haptics into the capsular bag in theposterior chamber of the eye comprising the steps of:(a) inserting alens guide having a body portion and a flap portion integrally connectedby a resilient connecting portion said connecting portion permittingsaid flap portion to be folded against the body portion to facilitateinsertion into the eye through an incision in the eye;continuinginsertion through said incision and through the pupil until said flapportion passes the superior side of the pupil and unfolds under theinfluence of the resilience in said connecting portion; (b) withdrawingthe body portion of said guide superiorly until said unfolded flapportion approaches the superior edge of the pupil; (c) inserting thelens through the incision; (d) placing the inferior haptic of said lensin the capsular bag; (e) placing the optic of said lens into thecapsular bag; (f) inserting the superior loop of the lens past saidconnecting portion of said lens guide and letting said superior loopmove along said flap portion into said bag; and (g) removing the guidefrom the eye.
 2. The method of claim 1 wherein the removing stepincludes the step of inserting a stylus having a distal end through theincision along the body portion of said guide and against said flapportion;retracting the body portion of said guide so that said flapportion touches the distal end of the stylus; so as said body portion isfurther withdrawn, said flap portion straightens out to facilitateremoval of the guide.
 3. The method of claim 2 including the furtherstep of:inserting a hollow insertion tube having a distal end into theeye; inserting said lens guide through said hollow insertion tube;removing said guide by moving said insertion tube forward to engage saidunfolded flap portion and then withdrawing said body portion of saidguide through said tube and using said distal end of said insertion tubeto straighten out said flap portion.
 4. The method of claim 3 furtherincluding the step of:inserting a flat, planar insertion glide throughsaid insertion tube into the eye through the pupil and toward theinferior internal surface of said capsule; sliding said lens along thesurface of said insertion glide until said inferior haptic of said lensis placed in the capsular bag; retracting the lens glide out of saidinsertion tube and out of the eye.